Should we be testing for COVID-19 after death? An Ontario man thinks so

An Ontario man says he wants to see more post-mortem COVID-19 testing, after a Windsor hospital denied a swab test request following the death of his grandmother.

In June, Ada Lidwell was admitted to Windsor Regional Hospital after she fell and fractured her hip.

The 103-year-old was swabbed for COVID-19 upon arrival, ultimately testing negative.

"They did great in making sure no one could come visit her until they got the results of that test," said Ottawa resident Steve Saunders, Lidwell's grandson. 

More than a week after surgery, Saunders said, Lidwell developed severe pneumonia, dying on June 23.

Expressing concern about possibly harming family present for Lidwell's funeral, Saunders asked hospital staff to swab his dead grandmother, only to be told that post-mortem COVID-19 tests are against hospital policy.

"We had a discussion about how this made no sense if the hospital was at all serious about contact tracing," said Saunders. "Obviously you always want to establish if there is a patient zero in any infection chain."

Though Saunders continued to petition to the hospital for a test, his request was nonetheless denied. 

Not wanting to upset his family by delaying Lidwell's funeral proceedings any longer, Saunders said he gave up on his request.

We had a discussion about how this made no sense if the hospital was at all serous about contact tracing.- Steve Saunders

When asked by CBC News, a spokesperson for Windsor Regional Hospital said via email that "our policies reflect active patients."

"A deceased patient is under the jurisdiction of the coroner's office," said Steve Erwin, manager of corporate communications, government and community relations for Windsor Regional Hospital.

Dr. Paul Ra, the coroner responsible for investigating the death of Lidwell, says there was no obvious reason to conduct a post-mortem test.

According to Ra, the decision to conduct a COVID-19 swab test on a deceased patient "is a clinical decision based upon previous testing results, the timing of any previous testing and the circumstances of the death."

"In this particular case, all of this was followed properly," wrote Ra, adding that post-mortem tests are conducted on patients who had symptoms of COVID-19, including "fever, coughing, shortness of breath."

Though Lidwell developed pneumonia, Ra said that his clinical judgment led him to believe that "pneumonia on June 22nd is very unlikely to be COVID-19."

"When I finished my investigation of the death of this remarkable lady and was home, somebody in hospital phoned me telling me that the family wanted to have [a] COVID-19 test done on their loved one," wrote Ra. "But the body has been already transferred to the morgue at that time. So we couldn't do it."

According to Ra, if Lidwell's body was still at her ward in hospital, "we would have done it."

"As coroner, I will listen to the family."

As for why Ontario hasn't mandated wide-spread COVID-19 testing — specifically wide-spread testing of everyone who has died since the pandemic was declared — Dr. Dirk Huyer, Ontario's chief coroner, explained that testing everyone "would be not of value."

Huyer said that attending physicians and coroners who suspect that a person may have died due to reasons related to COVID-19 are still able to list "probably COVID-19" as a cause of death.

For his part, Dr. Prabhat Jha, an epidemiologist at the University of Toronto, and director of the Centre for Global Health Research at St. Michael's Hospital in Toronto, said he's not aware of any province in Canada that has mandated wide-scale post-mortem COVID-19 testing.

However, when it comes to coding causes of death during this particular pandemic, Jha said the World Health Organization has issued guidelines clearly stipulating that COVID-19 can be a cause of death "if they had biological testing or they can be coded on a presumptive basis."

"I think it's fair to say in Canada those are not being followed uniformly," Jha said. "So in some places they're only coding deaths that had a laboratory confirmation, in other places they're coding both."

"But the general rule of thumb in a pandemic is don't miss any deaths."

Jha said people should "err on the side of coding things that were suspect COVID-19 deaths as COVID-19 deaths."

At the same time, he said an argument can be made that hospitals should be conducting post-mortem testing for COVID-19 "in suitable circumstances."

"Not everybody, but potential suspect cases, they should be testing for COVID-19 and noting that in the record," he said.